Provider Demographics
NPI:1821712381
Name:AEOMMUN, AKKARAWEE
Entity Type:Individual
Prefix:
First Name:AKKARAWEE
Middle Name:
Last Name:AEOMMUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11656 STAGG ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-2640
Mailing Address - Country:US
Mailing Address - Phone:818-469-9911
Mailing Address - Fax:
Practice Address - Street 1:11656 STAGG ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-2640
Practice Address - Country:US
Practice Address - Phone:818-469-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist